Hand surgery is a very specialized surgical branch within the fields of both orthopedics and plastic surgery,
Carpal Tunnel Syndrome
This disease is seen mostly in people who have hobbies or who do repetitive hand and wrist movements as a requirement of their works. It is the condition, in which one of the three nerves (median nerve) related to the hand is compressed at the level of wrist Patients usually apply to a medical center when they feel a numbness, pain or tingling in their arms, hands or fingers. The median nerve and the accompanying nine tendons pass through a tunnel called “carpal tunnel” in the wrist and reach the hand after the forearm. The pressure developing due to any swelling in that tunnel leads to some symptoms such as numbness, pain, and tingling.
Its cause is usually unknown. The tunnel is likely to become narrow due to swellings that develop in the tendon sheathes, joint dislocations, fractures or arthritis.
Sensations defects and tingling are usually seen in the thumb, index finger, middle finger or ring finger. Sometimes, there may be complaints such as difficulty in grasping by hand, decrease in the manipulative skills, or dropping the objects when carried by hand.
Resting the wrist with various splints can lead to a decrease in the symptoms in some patients. Cortisone injection into the carpal tunnel may improve the symptoms, as well. If symptoms are very severe or cannot be improved despite the precautions taken, surgical intervention is needed. In the surgical treatment, the ligaments constituting the upper part of the tunnel are cut, in order to relieve the Carpal tunnel. Although numbness and tingling almost disappear after surgery, recovery of the strength takes a couple of months.
Trigger Finger (Stenosis of Tenosynovitis)
Trigger finger is a disorder related to the tendon and pulley system that moves the fingers. Tendons can be defined as strings connecting the muscles and bone in the arm. And the pulleys are the rings, through which these strings pass. These keep the tendons close to the bone.
If the movements of the tendon become difficult due to the thickening in the pulley system, the condition called ‘trigger finger’ emerges. Sometimes a swelling may occur on the tendon. Since the movement of the tendon in this pulley system becomes difficult, a pain may be felt and an uneasiness and inhibition may occur. Edema increases in parallel with the increase in the pressure on the tendon, and consequently, a vicious circle develops.
Splints and cortisone can be applied in the treatment. If these treatments do not give favorable results, a surgical procedure is performed. Surgery can be performed under local anesthesia. The aim is to relieve the movements of the tendon by widening the area where it is stuck. Normal hand movements can be made immediately after the surgery.
Ganglion
Cysts called ‘ganglion’ are commonly seen in the hand and wrist area close to the tendon and the joints. They are mostly seen on the upper outer part of the wrist, on the inner part of the wrist, on the palms, on the bases of the fingers, and on the fingertips. Ganglions are balloon-shaped cysts filled with a jelly-like fluid. The sizes of cysts can vary in the course of time, or they can completely disappear. Some of them do not cause pain, whereas some others cause severe pains.
If the cyst causes pain or cosmetically annoy the patient, it should be surgically removed.
Amputations
Complete removal or rupture of a certain part of the body due to injury or tumoral causes is called ‘amputation’. Amputations may be caused by traumatic injuries, and sometimes can be done based on a planned operation. In some cases, traumatically ruptured fingers can be replanted in their places, but this may not be possible in some cases.
Surgically performed amputations are done in such a way as not to require prostheses, or the remaining part is made suitable for prosthesis applications.
Replantation
Surgeries performed with intent to reattach body parts such as the arms, hands and fingers after their amputation is called replantation. The aim of replantation is to bring back as much function as possible. If the amputated part has been damaged too much, replantation may be impracticable. In such a case, prostheses can be used.
Congenital Hand Problems
Congenital hand problems are seen in one out of every 20 children. The most common congenital hand problems are syndactyly (fusing together or webbing of fingers or toes) and polydactyly (extra finger in the hand).
Families with a child who has a congenital hand problem feel confused, angry and guilty. These are normal for the early stage. In the course of time, these feelings will cool down, and the families will understand the fact that it is not their fault.
After surgical treatment of an important part of congenital hand problems, the resultant appearance and functionality become normal or close to normal.
Traumatic Injuries
Such injuries occur mostly due to occupational accidents or traffic accidents. The injury may be in the tendons, blood vessels, and nerves in the hands and fingers, or on just the hand’s skin. Emergency treatment is of great importance in hand injuries. The elapsed time may adversely affect the results to be obtained.
Tumors
Tumors or cysts that originated from the tendon or bone can be encountered, in addition to all soft tissue tumors (benign or malignant) seen in the hands and other parts of the body. Since all formations in the hand are essential structures, they require much more precise and careful surgical interventions compared to surgical operations done in other parts of the body.